Investigation on the Influential Factors of TCM Service Utilized by Outpatients in Jiangsu Province / 中国药房

OBJECTIVE：To investigate the influ ential factors of traditional Chinese medicine （TCM）service utilized by outpatients in Jiangsu province ，and to provide reference for scientific utilization of TCM service. METHODS ：Based on the data of Jiangsu province in National Sixth Health Service Survey in 2018，descriptive analysis was performed for the general situation and population characteristics of 1 617 outpatients in Jiangsu province. Single factor analysis and multivariate binary Logistic regression model analysis were used to analyze the influential factors of TCM service utilized by outpatients. RESULTS ：Of the 1 617 respondents，145 patients（9.0％）applied TCM services at outpatient visits. Results of single factor analysis showed that age ， education degree ，annual income ，whether to participate in basic medical insurance ，self-perceived illness severity ，hypertension， diabetes，other chronic diseases ，and the first diagnose institutions were significant influential factors for TCM service utilized by outpatients in Jiangsu province （P＜0.05）. Results of binary Logistic regression showed that the elderly aged 65 years and over ， the patients who participated in the basic medical insurance for urban workers ，the patients with hypertension ，primary medical institutions as first diagnosis institutions ，the middle-income population ，and other chronic diseases were significant influential factors for TCM service utilized by outpatients in Jiangsu province （P＜0.05）. CONCLUSIONS ：Age，annual income ，whether to participate in basic medical insurance ，hypertension and other chronic diseases ，and first diagnosis institutions are significant infleutial factors for TCM service utilized by outpatients in Jiangsu province. The utilization of TCM health services for outpatients in Jiangsu province is in relatively low level ，and middle-aged and elderly patients and patients with chronic diseases show high acceptance for TCM services. Outpatients first diagnosed in primary medical institutions are more willing to accept TCM services.

Research on the Development Status and Suggestions of TCM Enterprises of Nantong City / 中国药房

OBJECTIVE： To study the development status of TCM enterprises of Nantong city and provide suggestions， and to promote the sustainable development of TCM enterprises of Nantong city. METHODS： Taking Nantong city as an example， questionnaires were issued to 15 TCM enterprises in Nantong （including 4 TCM decoction piece enterprises， 11 TCM pharmaceutical preparation enterprises）. The statistical analysis was carried out in respects of scale structure， development （including economic development and staff） and development potential （by enterprise R&D funds and R&D personnel input intensity） of enterprises during 2013-2017. RESULTS & CONCLUSIONS： In terms of the scale and structure of the enterprise， there were no large-scale enterprises in Nantong city， only 3 medium-sized enterprises， 12 small enterprises； the overall scale of enterprises was small； the overall concentration of TCM enterprises was not high， in which the market structure of TCM decoction piece enterprises was oligopolistic， and the structure of preparation enterprises was competitive. The concentration of TCM decoction enterprises was higher than that of TCM preparation enterprises. In terms of economic development， the annual average GDP and profit growth rate are 14.98％ and 19.09％ from 2014 to 2017； the economic development situation was good， but the brand variety advantage was not developed fully. In terms of staff， employee’s education level was mainly college degree （34.01％） and the staff category was mainly salesperson （32.73％）. In terms of the company’s development potential， enterprise R&D funds and R&D personnel input intensity were in low levels （average 2.96％， 11.32％ in 5 years）， the number of patents （16 in 2013 vs. 17 in 2017） and innovative products （7 in 2013 vs. 12 in 2017） increases slowly， and only one had opened up overseas markets. In response to the issues， TCM enterprises of Nantong city or other areas should merge and reorganize appropriately to expand the scale of the industry and improve the market concentration； increase research funds and talented personnel investment， insist the protection and in novation of TCM. In addition， build a big data “healthy cloud” platform to break the traditional industrial chain； at the same time， seize the “Belt and Road” policy finance and taxation opportunities to promote overseas and develop markets to promote the sustainable development of TCM enterprise.

Development Research of City-level Drug Quantity Purchasing Mode and Analysis of Drug Purchase Mode in Cities of Fujian Province / 中国药房

OBJECTIVE:To provide reference for the further improvement of centralized drug procurement in China. METHODS:By retrieving Suggestions on Improving the Drug Centralized Purchase of Public Hospitals issued by State Council in 2015 and drug centralized purchase policy document issued by provinces (regions,cities),the development of drug quantity purchasing mode was investigated. The mode of drug purchase in cities of representative Fujian province was analyzed. RESULTS& CONCLUSIONS:As of Aug. 31st,2017,city-level quantity purchasing mode was implemented in 12 provinces (regions, cities). Specific mode included taking the form of medical partnerships as the main body [taking cities as unit,taking cities as unit+hospital,only one medical partnership in the region or city] and taking the form of the types of negotiated drugs as main body [negotiated price for network drugs in provinces (regions,cities),negotiated price for the whole variety]. 7 cities of Fujian province announced procurement programs,quotation and bargaining rules were formulated and entered the procurement stage. Relative departments should actively promote drug quantity purchasing mode in regions or cities and also pay attention to the relationship of drug price with the quality of drugs,the purchase amount of drugs and the payment of purchase loans,the"second bargaining""third bargaining"and so on.

Practice and consideration of the payroll reform for healthcare personnel in Jiangsu province / 中华医院管理杂志

The paper probed into the reform of healthcare personnel′s payroll system , identifying such problems as the staffing quota management system curbing rational flow of healthcare personnel ,lack of enthusiasm of such personnel ,delayed progress of the implementation of the occupational pension and the shortage of talents in urgent need.With current outcomes confirmed ,the authors recommended to remove the staffing quota system and introduce a market mechanism ;to build an income growth mechanism for higher incentives ;to enhance primary institutions′team building ,and develop talents in urgent need ;to unify social insurance standards and enhance local fiscal support .

Mechanism evolution and choice of future policy for drug price formation in public hospitals in China / 中国卫生政策研究

This paper firstly analyses the sales and purchase contracts in the procurement of drugs in public hospitals, and then points out the market failure in the two contracts. After the implementation of administrative measures such as government pricing, administrative price reduction, price increase, centralized bidding and purcha-sing, various drug procurement stakeholders have adopted various game behaviors, and government procurement and price formation have appeared in government hospitals, not-neglecting the formation of the price ofGovernment fail-ure. The future price formation in public hospitals should be the market pricing under the limited government regu-lation, and increase the medical insurance institutions' price negotiation and the public hospitals' participation degree in the bidding process based on maintaining the centralized bidding and purchasing and zero administrative rate.

USAPAP for treatment of posterior acetabular fractures / 中华骨科杂志

Objective To evaluate the clinical efficacy of universal self-locking anatomical plate for acetabulum and pelvis (USAPAP) in the treatment of posterior acetabular fractures.Methods Data of 55 patients with posterior acetabular fractures who were treated with the USAPAP from January 2014 to January 2016 were retrospectively analyzed.There were 39 males and 16 females with an average age of 38.5 years old (range,17-82 years).There were 35 fractures on the left side while the other 20 fractures were on the right side,including 52 fresh cases and 3 old cases.According to Letournel-Judet classification,there were 32 cases of posterior wall,9 cases of transverse and posterior wall,5 cases of anterior column and posterior wall,2 cases of posterior column,2 cases of transverse,2 cases of two columns,1 case of anterior column and posterior hemitransverse,2 cases of Pipkin type Ⅳ.All patients were managed operatively by the USAPAP,which allows simultaneous fixation for two columns and quadrilateral surface fractures through a single Kocher-Langenback approach.The quality of reduction was assessed by Matta's score system.The mean follow-up period was 18.5 months (range,12-24 months).Average operation time was 95 min,and average blood loss was 350 ml.Average operation time of plate and screws fixation was 19 min,and average fluoroscopy times in the surgery was 2 times.The mean time of bony union was 4.3 months.According to the criteria described by Matta,the excellent and good rate of radiological score was 92.7％ (51/55),including 39 cases excellent,12 cases good and 4 cases poor.The excellent and good rate of Merle d'Aubigne-Postel score was 87.3％ (48/55),including 35 cases of excellent,13 cases of good,5 cases of fair,and 2 cases of poor.Heterotopic ossification occurred in 1 patient (Brooker type Ⅱ) at three months postoperatively.One case with Pipkin type Ⅳ fracture underwent total hip arthroplasty due to femoral head necrosis at seven months postoperatively.Complications including wound infection,sciatic nerve injury,screw invade joint,redisplacement of the fracture,avascular necrosis of bone fragment,hardware failure,nonunion or malunion was not found in any case at the latest follow-up.Conclusion The USAPAP through the single posterior Kocher-Langenback approach provides strong and stable fixation for complex acetabular fractures associated with posterior region including posterior wall,both columns and quadrilateral surface.Satisfactory clinical results can be achieved by the use of this method.

Empirical study on the relationship between hospital governance structure and social responsibility / 中华医院管理杂志

This paper sampled 79 TCM hospitals above county level in Jiangsu Province for research.With hospital ownership,board governance and hospital directors as three dimension of internal governance structure,the multiple regression model was used to investigate the impact of such structure on its social responsibility performance.Education level,number of hospital directors,and their values are found to be significant factors on their social responsibility performance.

Alternation of mitochondrial Oxidative phosphorylation post-ischemia/reperfusion myocardial injury in mice / 实用医学杂志

Objective To investigate the alternation of mitochondrial oxidative phosphorylation post-ischemia/reperfusion myocardial injury in mice. Methods The C57BL/6 mice were randomly divided into five groups. The mouse hearts in the time control group (TC) were perfused for 45 min in identical Krebs-Henseleit buffer without any treatment. In the ischemia/reperfusion groups, the mouse hearts were treated with different reperfusion time including 5, 10, 15 or 30 min, following by the same ischemia period of 25 min. The mitochondria were extracted from the left ventricular post-reperfusion. The respiratory function including R3, R4, RCR, and the maximal rate of state 3 respiration (2 mmol/L ADP) were measured. Results The R3, RCR and P/O of mitochondria, using glutamate + malate as substrates, were decreased significantly at 10 min, 15 min and 30 min post-ischemia/reperfusion (P < 0.05, respectively), but not in the 5-min-reperfusion group compared with the time control group. And the respiratory function, using succinate, and TMPD-ascorbate as substrates, decreased significantly in different ischemia/reperfusion groups compared with the time control (P < 0.05, respectively). Conclusions The mitochondrial respiratory function changes differently in different complex at the early stage of reperfusion after ischemia. So different ischemia/reperfusion time should be chosen to detect the alternations of different mitochondrial complex after heart injury.

An empirical study on influencing factors of hospital social responsibility in China / 中华医院管理杂志

To identify the factors that affect the hospital social responsibility(HSR)level based on theoretical analysis.79 TCM hospitals in Jiangsu Province were surveyed with questionnaires,with the data analyzed by the multiple linear regression model.The research results show the following: 1. Hospital’s financial performance,hospital size,and the congress of medical workers are positive factors to the HSR level.2.Pressure from HSR performance of neighboring hospitals has a significant negative impact.3.Hospital’s financial performance and hospital size have a significant positive impact on its intention to fulfill HSR.4.Hospital location has a significant negative impact on its intention to fulfill HSR.

Impact of hospital attributes on hospital’s social responsibility behaviors / 中华医院管理杂志

Objective To study the relationship between hospital attributes and hospital social responsibility (HSR)behaviors,and measures to improve HSR performance.Methods 79 TCM hospitals in Jiangsu Province was surveyed with questionnaires for their HSR performance in 201 1 and 2012,with the data analyzed by independent two-sample t-test.Results In terms of HSR contribution,different levels of hospitals have statistical significance in bad debt,accomplishment of government mandatory missions,environmental protection,education and research,and social welfare activities.Hospitals in different regions have statistical significance in education and research,low-profit medical services and cheap drugs provision.Teaching hospitals make statistical significance in accomplishment of government mandatory missions,environmental protection,education and research,and social welfare activities.In terms of HSR willingness,different levels of hospitals have statistical significance in accomplishment of government mandatory missions,price discount,and education and research.Hospitals in different regions have statistical significance in health services with positive social effects,education and research,and social welfare activities.Teaching hospitals make statistical significance in education and research. Conclusions Secondary hospitals need to invest more resources on HSR.Hospitals in underdeveloped areas must pay more attention to environmental protection,education and research.Non-teaching hospitals need to strengthen quality of care,accomplishment of governmental mandatory missions and environmental protection.

Influence of Bupleurum Liver-Coursing Powderon behavior,neuronal apoptosis and autophage in hippocampus of depressive rats / 吉林大学学报(医学版)

Objective To observe the effect of Bupleurum Liver-Coursing Powder on the neuronal apoptosis and autophage in hippocampus of depression model rats, and to explore the mechanism of its anti-depression effect. Methods 60 male SD rats were randomly divided into control group,model group and drug intervention group (n=20).The depression model was produced by giving the rats chronic unpredicted mild stress.The rats in model group and control group received the same volume of normal saline,and the rats in drug intervention group received Bupleurum Liver-Coursing Powder solution on the basis of model.The depressional behavior was examined using sucrose preference test,tail-suspension test and Morris water maze.Flow cytometry was employed for the detection and quantification of the apoptotic cells in the hippcampus. The expressions of LC-3 and Beclin 1 were detected using Western blotting method. Results The pencertages of sucrose preference of the rats in model group and drug intervention group were significantly lower, while the tail-suspension immobility time and the excape latency time were higher than those in control group (P<0.05);the apoptotic rates of cells,the ratios of LC3-Ⅱ/LC3-Ⅰand the expression levels of Beclin-1 were higher than those in control group (P<0.05).Compared with model group,the percentage of sucrose preference of the rats in drug intervention group was increased (P<0.05),the tail-suspension immobility time and the excape latency time were decreased (P<0.05),and the apoptotic rate of cells,the ratio of LC3-Ⅱ/LC3-Ⅰand the expression level were also decreased (P<0.05).Conclusion Bupleurum Liver-Coursing Powder has significant anti-depression effect, which may be related to inhibiting the apoptosis and degrading the autophage of neuros.

Detection and significance ofC D4 +/CD 8 +T cells ratio and TGF-β,IL-4,IL-6 levels in lung cancer patients during perioperative peir od / 实用肿瘤学杂志

Objective To study the changes of CD4 +/CD8 +T cells ratio and TGF -β,IL-4,IL-6 levels in lung cancer patients during the perioperative period and to analyze the clinical significance .Methods Flow cytometer and Elisa were used to analyze the CD 4 +/CD8 +T cells ratio and TGF-β,IL-4,IL-6 levels in peripheral blood sapmles from 20 patients with lung cancer during the perioperative period and 10 healthy con-trolsR. esults Before operation ,the ratios of CD4 +T and CD8 +T cells from 20 patients with lung cancer were (46.26 ±4.26)%and(43.15 ±5.18)%, respectively.On the fifth day after operation ,the ratios of CD4 +T and CD8 +T cells were(44.30 ±4.25)%and(39.80 ±2.53)%.TGF-β,IL-4 and IL-6 levels in 20lung cancer patients were(240.51 ±46.37)pg/mL,(19.85 ±2.52)pg/mL,and(129.28 ±33.06)pg/mL,respectively.On the fifth day after operation,TGF-β,IL-4 and IL-6 levels were(210.79 ±36.94)pg/mL,(17.37 ±2.57) pg/mL,and(107.28 ±27.83) pg/mL.The differences of above parameters between the preoperative period and the fifth day after operation were statistically significant ( P<0.05) . Conclusion The immune suppression oc-curs before its recovery during perioperative period ,the changes of CD4 +/CD8 +T cells ratio and TGF-β,IL-4 and IL-6 levels have significance on monitoring the progress and prognosis of patients with tumor .

The dynamic research of Th17 cells, NK cells and IFN-γ, IL-17 in perioperative patients with lung cancer / 实用肿瘤学杂志

Objective To investigate the dynamic changes of Th 17 ,NK and IFN-γ,IL-17 in periop-erative patients with lung cancer .Methods Twenty cases of patients with lung cancer surgery were chosen ran-domly.Ten cases of healthy were used as control .We detected the express of Th17,NK,IFN-γand IL-17.Re-sults Compared with the control group , the levels of Th17 and IL -17 increased significantly in lung cancer group(P<0.05);Compared with the pre -operation,the levels of Th17 and IL-17 increased significantly after 1st day of lung cancer surgery .However,the levels of NK and IFN -γdecreased significantly .The expression of Th17 and IL-17 decreased obviously after 5 days of lung cancer surgery .However,the levels of IFN -γin-creased significantly(P<0.05).The correlation analysis showed that there was a positive correlation between Th17 and IL-17A,NK and IFN-γof peripheral blood with lung cancer patients (P<0.01),negative correla-tion between Th17 and NK,IFN-γof peripheral blood with lung cancer patients (P<0.05).Conclusion The immune suppress before activating at perioperative ,it is important for lung cancer patients to detect the levels of Th17,IL-17,NK,IFN-γin peripheral blood .

Study to determine the behavior expression system of hospitals' social responsibilities / 中华医院管理杂志

By means of literature review,the authors initiated the behavior expression system of hospitals' social responsibilities,which is further refined and revised with questionnaires and Delphi method.13 expressions of such behavior expressions were determined,namely “providing quality of care to patients”,“undertaking rescue assignment for emergencies”,and “fulfilling government-assigned tasks”.All of the 13 expressions were supported by 75％ of the experts during the second round of experts consultation.

Inhibition of glial activation in rostral ventromedial medulla attenuates mechanical allodynia in a rat model of cancer-induced bone pain / 华中科技大学学报（医学）（英德文版）

Descending nociceptive modulation from the supraspinal structures plays an important role in cancer-induced bone pain (CIBP). Rostral ventromedial medulla (RVM) is a critical component of descending nociceptive facilitation circuitry, but so far the mechanisms are poorly known. In this study, we investigated the role of RVM glial activation in the descending nociceptive facilitation circuitry in a CIBP rat model. CIBP rats showed significant activation of microglia and astrocytes, and also up-regulation of phosphorylated p38 mitogen-activated protein kinase (p38 MAPK) and pro-inflammatory mediators released by glial cells (IL-1β, IL-6, TNF-α and brain-derived neurotrophic factor) in the RVM. Stereotaxic microinjection of the glial inhibitors (minocycline and fluorocitrate) into CIBP rats' RVM could reverse the glial activation and significantly attenuate mechanical allodynia in a time-dependent manner. RVM microinjection of p38 MAPK inhibitor (SB203580) abolished the activation of microglia, reversed the associated up-regulation of pro-inflammatory mediators and significantly attenuated mechanical allodynia. Taken together, these results suggest that RVM glial activation is involved in the pathogenesis of CIBP. RVM microglial p38 MAPK signaling pathway is activated and leads to the release of downstream pro-inflammatory mediators, which contribute to the descending facilitation of CIBP.

Changes of behavior, Ca~(2+)/CaMKⅡ in hippocampus of rats with chronic forced swimming stress model / 解剖学报

Objective To observe the changes of behavior, intracellular free calcium and the expression of calmodulin dependent protein kinase Ⅱ(CaMKⅡ) in the hippocampal neurons of chronic forced swimming stress rats. Methods Male Wistar rats were randomly divided into control group and chronic forced swimming stress group. The behavior was examined using sucrose preference test, open-filed test and Morris water maze. The intracellular free calcium was examined by fluorescence spectrophotometer. The expression of CaMKⅡ was detected using colloidal gold immunoelectron microscopy technique, Western blotting and RT-PCR. Results The consumption of sucrose and erect quantity of chronic forced swimming stress group were lower than those of control group(P<0.01, P<0.05). The escape latency time in Morries water maze test of chronic forced swimming stress group was higher than that of control group(P<0.01). The intracellular free calcium level and the expression of CaMKⅡ in the hippocampus was higher than that of control group(P<0.01).Conclusion The lasting dysfunction of Ca~(2+)/CaMKⅡ signaling cascades in hippocampus may play important roles in the pathogenesis of chronic forced swimming stress rats.

Analgesic effects of the selective blocking of descending facilitation targeting μ, opioid receptor positive neurons in a rat model of bone cancer pain / 中华麻醉学杂志

Objective To investigate analgesic effects of the selective blocking of descending facilitation targeting μ opioid receptor positive neurons in the rostral ventromedial medulla ( RVM) in a rat model of bone cancer pain. Methods Forty-eight adult female Wistar rats weighing 180-200 g were randomly divided into 6 groups: group Ⅰ control ( n = 3) ;group Ⅱ bone cancer pain induced by intra-tibia inoculation of Walker 256 mammary gland carcinoma cells ( n = 9) ;group Ⅲ-Ⅵ received a single intra-RVM micro-injection of PBS (group Ⅲ), dermorphin (group Ⅳ) , saporin (group Ⅴ) and dermorphin-saporin ( group Ⅵ) respectively at 28 days before intra-tibia inoculation ( n = 9 each) . Starting from 3 to 20 days after intra-tibia inoculation, mechanical allodynia was assessed and recorded. The animals were sacrificed on 7, 14 and 20 days after intra-tibia inoculation, after repetitive non-noxious tactile stimulation of the hindpaw. The total number of Fos-positive neurons in the spinal dorsal horn was measured as a marker indicative of central sensitization. Results The animals developed nociceptive hypersensitivity after intra-tibia cancer cell inoculation in group Ⅱ -Ⅵ . Nociceptive hypersensitivity was significantly decreased during 4-7 days after the onset of nociception in group Ⅵ (dermorphin-saporin). The number of Fos positive neurons in bilateral spinal dorsal horn was significantly increased by intra-tibia inoculation of cancer cells in group Ⅱ-Ⅵ as compared with control group and was significantly lower at day 14 and 20 after inoculation in group Ⅵ (dermorphin-saporin) than in group Ⅱ - Ⅴ.Conclusion Selective blocking of descending facilitation targeting μ opioid receptor positive neurons in RVM can effectively reduce nociceptive hypersensitivity induced by intra-tibia inoculation of Walker56 mammary gland carcinoma cells.

Research on the Problems of Pharmaceutical Dispensing Fee Brought into the Scope of Basic Medical Insurance Compensation / 中国药房

OBJECTIVE:To investigate the countermeasures for the problems of pharmaceutical dispensing fee brought into the scope of basic medical insurance compensation under New Medical Reform.METHODS:The difficulties of scheme formulation and practical operation of pharmaceutical dispensing fee brought into the scope of basic medical insurance compensation were analyzed.Compensation method,compensation levels and related management supporting measures were investigated based on the experience of foreign and domestic experience.RESULTS & CONCLUSION:Referring to foreign and domestic experience,reasonable compensation scheme should be formulated to play the coupling effect of systems.The supervision and management mechanism should be improved to play the role of pharmaceutical dispensing fee in the control of drug expenses.

Study on Reform Mode for Township Hospitals in Zhangjiagang / 中国药房

OBJECTIVE:To provide reference for systematic reform in national state-owned hospital.METHODS:System reforms of township hospitals in Zhangjiagang were analyzed.Then three kinds of reform modes were summarized including privatization,town-owned-town-management and sino-foreign joint venture.Reform effects were also discussed.RESULTS & CONCLUSIONS:The achievement that the reformed township hospitals have made in Zhangjiagang in improving the medical insurance and pharmaceutical management system,reforming hospital management system and operation mechanism and creating a harmonious relationship between doctor and patient can provide a reference for domestic state-owned hospital reform.

Reassessment on the Impact of China's Entry into WTO on Chinese Pharmaceutical Industry / 中国药房

OBJECTIVE: To reassess the impact of China's entry into WTO on Chinese pharmaceutical industry.METHODS: The relevant viewpoints before the entry into WTO were reviewed and the development of the pharmaceutical industry after China's entry into WTO was analyzed,and the impact of China's entry into WTO on Chinese pharmaceutical industry was reassessed.RESULTS & CONCLUSIONS: China's entry into WTO enhanced the export of pharmaceutical products and the impact of TRIPS on pharmaceutical industry is as great as what people have predicated.To the opposite of some scholars' view,the steadily increased import of drugs after entering WTO had little impact on domestic pharmaceutical industry and the export of traditional Chinese medicine products still faces many difficulties.